Older adults and balance dysfunction.

Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
Neurologic Clinics (Impact Factor: 1.61). 09/2005; 23(3):785-805, vii. DOI: 10.1016/j.ncl.2005.01.009
Source: PubMed
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    ABSTRACT: BACKGROUND: There are several protocols designed to treat vestibular disorders that focus on habituation, substitution, adaptation, and compensation exercises. However, protocols that contemplate not only vestibular stimulation but also other components that are essential to the body balance control in older people are rare. This study aims to compare the effectiveness of two vestibular rehabilitation protocols (conventional versus multimodal) on the functional capacity and body balance control of older people with chronic dizziness due to vestibular disorders. METHODS: A randomized, single-blind, controlled clinical trial with a 3 months follow-up period will be performed. The sample will be composed of older individuals with a clinical diagnosis of chronic dizziness resulting from vestibular disorders. The subjects will be evaluated at baseline, post-treatment and follow-up. Primary outcomes will be determined in accordance with the Dizziness Handicap Inventory (functional capacity) and the Dynamic Gait Index (body balance). Secondary outcomes include dizziness features, functional records, body balance control tests, and psychological information. The older individuals (minimum sample n = 68) will be randomized to either the conventional or multimodal Cawthorne&Cooksey protocols. The protocols will be performed during individual 50-minute sessions, twice a week, for 2 months (a total of 16 sessions). The outcomes of both protocols will be compared according to the intention-to-treat analysis. DISCUSSION: Vestibular rehabilitation through the Cawthorne&Cooksey protocol has already proved to be effective. However, the addition of other components related to body balance control has been proposed to improve the rehabilitation of older people with chronic dizziness from vestibular disorders.Trial registration: ACTRN12610000018011.
    Trials 12/2012; 13(1):246. · 2.12 Impact Factor
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    ABSTRACT: The Vestibular Disorders Activities of Daily Living Scale (VADL) assesses the impact of dizziness and body imbalance on the everyday activities of patients with vestibulopathy. The scale encompasses 28 activities divided into three sub-scales (functional, ambulation and instrumental). OBJECTIVE: To translate and cross-culturally adapt the VADL to the Brazilian Portuguese language and verify its reliability. METHOD: Questionnaire translation methodological research. Eighty elderly subjects (age > 65 years) with chronic dizziness arising from vestibular disorders were enrolled, of which 40 participated in the pre-testing stage and 40 in reliability analysis. Concordance Correlation Coefficient (CCC) analysis was used to assess reliability. Internal consistency was estimated using Cronbach's alpha (α). RESULTS: Pre-test analysis revealed 15% of incomprehension on two activities; these items had to be adapted. The VADL-Brazil had similar levels of test-retest and inter-rater reliability for total score and presented substantial agreement (CCC = 0.79). Internal consistency was excellent for total score (α = 0.92), good for the functional (α = 0.89) and locomotion (α = 0.86) sub-scales, and poor for the instrumental subscale (α = 0.56). CONCLUSION: The Brazilian version of the VADL was proven adequate, with good levels of reliability and internal consistency. It might be thus considered as an alternative to assess the functional capacity of vestibulopathy patients.
    Brazilian journal of otorhinolaryngology 04/2013; 79(2):203-211. · 0.55 Impact Factor
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    ABSTRACT: The ageing neuromuscular system is affected by structural and functional changes that lead to a general slowing down of neuromuscular performance and an increased risk of falling. As a consequence, the process of ageing results in a reduced ability to develop maximal and explosive force, as well as in deficits in static and dynamic postural control. A decrease in the number and size of type II fibres in particular accounts for the age-related decline in muscle mass (sarcopaenia) and strength performance. Multiple denervation and re-innervation processes of muscle fibres seem to be responsible for the reduced number of muscle fibres. Recently, it has been suggested that it is not the decline in motoneurons that accounts for the loss in number of muscle fibres but the disturbed potential of fibre regeneration and re-innervation. Furthermore, an age-related reduction in the number of satellite cells has also been associated with sarcopaenia. The ability to compensate for platform and gait perturbations deteriorates with ageing as reflected in longer onset latencies and inefficient postural responses. All sites within the somatosensory system are affected by ageing and therefore contribute to postural instability. However, morphological changes of muscle spindles appear primarily to be responsible for the impaired ability to compensate for balance threats in old age. Given these neuromuscular limitations in old age, it is important to apply adequate training interventions that delay or even reverse the onset of these constraints. Strength training has the potential to enhance maximal as well as explosive force production capacity. This is accomplished by neural factors, including an improved recruitment pattern, discharge rate, and synchronization of motor units. Furthermore, an increase in number of satellite cells most likely accounts for training-induced muscle hypertrophy. Recent studies have investigated the impact of balance training in old age on the ability to develop maximal and explosive force. In addition, the effects of balance training on reflex activity during gait perturbations were also examined. Increases in maximal and explosive force production capacity and an improved ability to compensate for gait perturbations were observed. It is evident from the literature that researchers are increasingly studying the effects of more specifically designed training programmes on performance in populations of older adults. Thus, in the near future, strength training could be replaced by high-velocity forms of power training and balance training by perturbation-based training programmes. It is hypothesized that this new approach is more efficient in terms of fall prevention than the traditional approach
    European Journal of Sport Science 11/2008; 8(6):325-340. · 1.31 Impact Factor